Gynaecology for students and practitioners . Fig. 307. Pessaries eor Backward Displacement, (a) Hodge Pessary • (b) Albert Smith Pessary. Note that the lower end of (a) is square, and its profile-curve is more pronounced than (6). position is the most useful {see Fig. SO, p. 126). The index and middlefingers of one hand are first passed into the posterior vaginal fornix,and with them pressure is made upon the fundus of the uterus in anupward and forward direction towards the pelvic brim {see Fig. 303,. Fig. 308. How to hold the Hodge Pessary, p. 578). With the assistance which the Simss positi
Gynaecology for students and practitioners . Fig. 307. Pessaries eor Backward Displacement, (a) Hodge Pessary • (b) Albert Smith Pessary. Note that the lower end of (a) is square, and its profile-curve is more pronounced than (6). position is the most useful {see Fig. SO, p. 126). The index and middlefingers of one hand are first passed into the posterior vaginal fornix,and with them pressure is made upon the fundus of the uterus in anupward and forward direction towards the pelvic brim {see Fig. 303,. Fig. 308. How to hold the Hodge Pessary, p. 578). With the assistance which the Simss position lends to thismanoeuvre, the fundus can easily be raised to the level of the sacralpromontory ; but the most difficult part of the reduction remains. Ifthe abdominal walls are thin and lax, they can now be depressedby the fingers of the other hand until these pass behind the uterinefundus, which is then gently directed forwards towards the symphysis,while the internal fingers push the cervix upwards and backwardstowards the sacral hollow, as shown in Figs. 304 and 305. The second and third stages can often be best carried out after 582 GYNECOLOGY getting the patient to turn over on her back, while the operator keepsthe uterus in the position to which he has raised it. With the com-plete muscular relaxation of general ansethesia, the aid of Simssposition is not required, and the whole procedure can be carried outwith the patient on her back. If the uterus cannot be replaced by thefinger alone
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